The overall goal of the proposed epidemiologic investigation is to conduct a comprehensive diagnostic, phenomenological, familial, and psychosocial evaluation of a sample of newly diagnosed psychotic patients and to assess changes in psychosocial and clinical status over a two-year period. In addition to assessing classical prognostic factors, such as premorbid adjustment, characteristics of illness onset, precipitating events, quality and severity of psychotic symptoms at the index episode, and family history of mental disorder, the proposed study will investigate the occurrence, stability, and consequences of suicidal ideation, suicide attempts and substance abuse in this population. Over a two year period, all first lifetime contacts to mental health facilities in Suffolk County, New York, will be screened for potential inclusion in the project. Patients satisfying an initial screen will be administered a comprehensive diagnostic evaluation, which will be repeated six months later. At that time, patients with a confirmed newly diagnosed psychosis will be classified as having schizophrenia or a non-schizophrenic disorder. They will then be given a psychosocial interview and their family members will be assessed diagnostically. Two years from initial contact (18 months from the psychosocial interview), the diagnostic and psychosocial assessments of the patients will be repeated. The significance of the proposed study of a large, representative sample rests on its attention to: newly diagnosed patients rather than a mixed sample of first and readmission cases; longitudinally determined diagnoses rather than cross-sectional categorization; the inclusion of patients with coexisting substance abuse and other psychiatric disorders who typically were excluded from prior studies; the relative effects of patterns of psychotropic medication; the comparison of schizophrenic and non-schizophrenic psychotic patients which will provide rigorous tests of the specificity of findings on prognostic indicators; obtaining direct diagnostic information on first-degree relatives; and detailed information on suicidal behaviors. Our success in conducting the proposed study will determine the advisability of further following this cohort and their first-degree relatives.
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